ICD TORIC 16.5 - OVAL KERATOCONUS

Scleral contact lenses are bigger in diameter than regular contact lenses they can be over 18mm and can be sub-categorized into Semi/Mini scleral lenses - those having a smaller diameter between 14.5 to 17.00 mm such as the ICD/ ICD FLEX FIT (Irregular Corneal Design) lenses.

The new generation of scleral lenses has become increasingly popular among eye care practitioners for dealing with irregular corneas, ectasias, significant astigmatism or Dry Eye Syndrome.

Compared to corneal GP lenses, the ICD scleral lenses provide substantial improvement in visual acuity with good comfort for many hours during the day.

The ICD scleral lenses are a good solution for patients who suffer from problems due to irregular corneas and provide significant improvement in their quality of life, especially for those who have failed with

corneal GP lenses.

23 Y/O patient
Female
In general good health, does not take medication.
The patient does not use any spectacles or contact lenses.
The keratoconus was diagnosed 4 years ago with Oval keratoconus in both eyes, more severe in OS,but did not receive any specific treatment.

Rx OD: Pl-2.75x50 VA 6/8.5

Rx OS: +1.00-3.00x70 VA 6/30

K READING:

OD:7.28 mm @53° / 6.64mm @ 143°

OS: 6.89 mm @ 131°/ 6.13 mm @ 41°

The difference between the steep K and the flat K is around 17D.

There is a big gap in front of the visual axis which can dramatically affect vision quality.

Good candidate for the ICD Semi Scleral.

The difference in OS is greater around 21D, and this can explain the severe vision impairment in the left eye. Good candidate for the ICD Semi Scleral.

Fitting Procedure

Selecting the initial lens using the table:
When we use the table, first of all we need to identify the corneal condition.

In our case the patient has Oval keratoconus, we chose Sag 4500𝝁.

When we inserted the lens we saw apical touch in the center so we changed the Sag to 4800𝝁= 4500𝝁+300𝝁 clearance

In many cases, selecting toric periphery lenses improves the fitting.
The reason is that most of the scleras are toric.
Selecting a lens with toric periphery design has the following
advantages:
1. Better stability
2. Better centration
3. Improved comfort
4. Ability to prescribe front toric correction.

Our initial lens was ICD 16.5 SPHERE 4500𝜇 as recommended in the manufacturer’s fitting table.
The fluorescein pattern showed central touch.
The second lens was 4800𝜇 but it didn’t have a good periphery pattern, we then changed the lenses to toric periphery with the same Sag.
The fluorescein pattern looked better.

LENSES PARAMETERS ORDER:

OD: ICD TORIC 16.5/ 4800/ -8.50/SLZ-1/ LCZ +3 VA 6/6

OS: ICD TORIC 16.5/ 4800/-9.00/ SLZ -1/LCZ +3 VA 6/6

Right eye

Fluorescein pattern

A good clearance can be seen in the center and periphery.
The dots are a reflection from the UV lamp.

It is a good way to take a picture with magnification.

Left eye

Proper Central Corneal Clearance - Correct Sag

Proper flow of blood vessels

SLZ(OS) - SLIT LAMP

One hour after lens has been inserted the Scleral landing zone was evaluated for proper flow of blood vessels.

(UV lamp - (Burton Lamp

An effective tool for contact lenses fitting, especially for scleral lenses.

It enables first evaluation of fitting and shows the fluorescein pattern with UV light or a white light with magnification.

The UV lamp is a portable aide for the practitioner, shortening contact lens fitting procedure time.

The patient feels very happy and comfortable with her new pair of contact lenses. She wears the lenses approximately 10 hours a day.
ICD Semi Scleral lenses provided a good solution for irregular corneas, especially with significant asymmetry that can be more challenging for special corneal GP lenses.
ICD Toric has many advantages such as centration, comfort, stabilization and optimal fitting for patients with toric scleras.
It can be prescribed with front toric prescription.
The results are better vision, comfortable wear for many hours a day and improved quality of life.

For printing press on the link below

https://content.vp4.me/soflexltd/Content/Case report - oval keratoconus ENG.pdf

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